If You Get a Bill or Statement

When Can a Provider Bill Me?

Providers may bill you if: 

• You did not pay your child’s copayment. 
• Your child received services from an out-of-network provider without approval from Keystone First – CHIP, the provider told you before your child received the service that the service would not be covered, and you agreed to pay for the service.
• You child received services that are not covered by Keystone First – CHIP, the provider told you before your child received the service that the service would not be covered, and you agreed to pay for the service.
• Your child received a service from a provider who is not enrolled with the Commonwealth.
• Your child goes over a benefit limit on a service.
• Your child received a medical service that is not a covered benefit.

Out-of-network providers are not allowed to bill Enrollees for services above and beyond Keystone First – CHIP’s agreed upon reimbursement rate. This means that, other than in the above circumstances, you should not receive a bill from an out-of-network provider. If you do receive a bill from an out-of-network provider, call Enrollee Services at 1-844-472-2447 (TTY 711) immediately so the situation can be resolved as soon as possible.

What Do I Do if I Get a Bill?

If you get a bill from a Keystone First – CHIP network provider and you think the provider should not have billed you, you can call Enrollee Services at 1-844-472-2447 (TTY 711). If you get a bill from a provider for one of the above reasons that a provider is allowed to bill you, you should pay the bill or call the provider.